Rolle Dermatology & Skin Surgery

1. Preparation for your surgery

Should you require a surgical procedure this may be performed on the day of your appointment in clinic here at Treetops Surgery. The procedure will be performed under a local anaesthetic. You are able to eat and drink as usual prior to the procedure. It is recommended that you have someone accompany you to the hospital as you may not be able to drive home, particularly after surgery to the face, neck, head or hands.

Please do not stop taking your usual medication ahead of your appointment; and check to see if any of the following areas are applicable to you:

Smoking: Impairs the skin’s ability to heal. If you are able to stop smoking for 2 weeks before and after the operation the overall wound healing will be improved.

Blood thinners:

• Aspirin. If you take a ‘mini aspirin’ daily continue to take it, but please inform us at the time of surgery.
• Warfarin. The INR ideally should be less than 3. Please get your INR checked 2 days before the procedure. Do not alter your warfarin dose unless this has been advised by the doctor prescribing the warfarin. Please bring your anticoagulation book to the operation.

Medical Conditions: If you have diabetes, epilepsy, a bleeding disorder (including a low platelet count), a pacemaker, cochlear implant or any implantable device, prosthetic heart valves or any other significant medical conditions then please let us know.

Allergies: Please inform of any allergies, particularly to antibiotics, dressings, latex and anaesthetics.

2. The procedure

Local anaesthetic will be injected into the site for your required surgical procedure. This causes a stinging sensation lasting several seconds. The area then becomes numb and no discomfort should be felt. The lesion is biopsied or excised and sent to the laboratory for pathological analysis (checked under a microscope). The wound may be closed with stitches – on the skin surface and often underneath the skin (these will dissolve over several months). A dressing will be applied. If you have had a skin flap or graft performed the dressing may be quite large and bulky. Occasionally, you may be prescribed a course of antibiotic tablets to be taken after the surgery. It is important that we know if you have any antibiotic allergies. Further information on the types of surgical procedures carried out by our surgical team are provided at the end of this page.

3. Skin biopsy analysis

All skin surgery specimens are sent to our pathologists for analysis. The result is usually available within 4 weeks but may take longer if further analysis is needed to reach a diagnosis. A member of  our team will either write to you, or contact you over the phone with the results, or request a follow up appointment to see you.

4. Care for your surgical wound

Keep the area completely dry for 48 hours. At this stage the dressing can usually be removed. The area can be gently washed once a day, and you can apply a thin smear of ointment. If you prefer you can keep the wound covered with a simple dressing which should be changed daily. If the wound starts to bleed, apply firm continuous pressure for 30 minutes. Slight bleeding in the few hours after surgery is common and is aggravated by activity. Hot drinks or bending down can cause bleeding, especially on facial wounds. Swelling and bruising is common, especially after facial surgery, and can be lessened by use of an ice pack. Use extra pillows after facial surgery and elevate the leg after lower limb surgery.

Do not use make-up near a wound until the surface has completely healed. Avoid swimming until the stitches are removed. The scar will be strong by 30 days – and is at its weakest during the first few days after the stitches have been removed. Too much activity can put strain on the healing scar. This can lead to stretching of the scar or bursting of the wound. Surgical wounds on the lower leg generally take a lot longer to heal.

5. Pain Care

When the local anaesthetic wears off after 2 to 3 hours, the area may be uncomfortable. Take 2 paracetamol (500mg) tablets every 4 to 6 hours (a maximum of 8 tablets in 24 hours). It is better to avoid aspirin or ibuprofen as pain relief on the day of the procedure as occasionally they can contribute to bleeding. Alcohol – do not drink any alcohol for 24 hours after the operation.

6. The scar

All skin surgery results in permanent scar formation. Scar tissue is red for 3 to 6 months and then usually fades to white. The appearance of a scar usually improves over 12 months as it 'matures'.

7. Removal of stitches

This will be between 5 and 21 days after the procedure depending on the part of the body. This can either be done at (trust name) or by arrangement with the practice nurse at your GP surgery.

For further information please contact either:

Dr Willcock for skin cancer work or Dr Harris for benign skin lesion work.

Risks of Skin Surgery

Most surgery goes well, however, anyone having surgery needs to be aware of the possible complications.

Scarring

It is impossible to cut the skin without scarring in some way. In addition, scars in areas under tension may spread so that the resultant scar is wider than it was at the end of the operation. For the majority of people the scar will be red and raised for the first 3 months but usually reduces in colour over the first year.

Keloids or hypertrophic scarring

Some people have an abnormal response to skin healing and these people form scars that are red and raised.

Nerve damage

All surgery to the skin inevitably cuts small nerves. Occasionally, numbness or pins and needles around the wound may follow surgery and last for some weeks or occasionally months but recovery almost always occurs.

Infection

Signs of infection may include the wound becoming painful, red, swollen or inflamed, or an unpleasant smell or leakage of fluid from the wound.

Recurrence/Incomplete excision

It is possible that not all of the skin lesion will be excised at the first attempt. Sometimes further surgery is recommended if this is the case.

If you would like to view our Consent form that you will asked to sign on the day surgery, please contact the practice.